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Comparative Study
Clinical features of precocious, synchronous, and metachronous brain metastases and the role of tumor resection.
- Ichiyo Shibahara, Masayuki Kanamori, Takashi Watanabe, Akihiro Utsunomiya, Hiroyoshi Suzuki, Ryuta Saito, Yukihiko Sonoda, Hidefumi Jokura, Hiroshi Uenohara, and Teiji Tominaga.
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
- World Neurosurg. 2018 May 1; 113: e1-e9.
ObjectiveThe purpose of this study was to clarify clinical features, outcomes, and the role of tumor resection in precocious, synchronous, and metachronous brain metastases.MethodsBrain metastases were found before primary cancer detection in the precocious group, within 2 months after primary cancer detection in the synchronous group, and 2 months or later after primary cancer detection in the metachronous group.ResultsOf 471 patients with brain metastases, 93 (20%) were included in the precocious group, 76 (16%) in the synchronous group, and 302 (64%) in the metachronous group. The precocious group tended to be symptomatic, show a low Karnofsky Performance Status, and have a large single tumor, infrequent extracranial metastases, and frequent tumor resection compared with the other 2 groups. There were no differences in overall survival from the detection of brain metastases among the 3 groups in univariate and multivariate analyses. Of 471 cases, 97 (21%) underwent surgeries. Among this surgical cohort, overall survival from surgery was significantly shorter in the precocious group than in the metachronous group (P = 0.039). After adjustment for age, sex, tumor size, primary cancer, and the Graded Prognostic Assessment score, the hazard ratio for metachronous metastases was 0.52 (confidence interval, 0.29-0.95; P = 0.035).ConclusionsThe timing of brain metastasis diagnosis is not a modifiable factor but affects patient demographics and treatment strategies. In particular, the precocious group is a unique subset of brain metastases that require special consideration during clinical decision making.Copyright © 2017. Published by Elsevier Inc.
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